As massage therapists, we know physically active people are less prone to chronic musculoskeletal pain problems. As I like to say, “Motion is lotion.” We must pull and stretch muscle and fascia through movement if we want these tissues to remain elastic, hydrated, and healthy.

What many massage therapists don’t always consider is the importance of mobility to the health of our nervous systems. Nerve fascicles, like muscle fascicles, are wrapped in layers of connective tissue that can stiffen, adhere, and become ischemic if we don’t move and stretch them regularly through active movement. And like tight muscles, restricted nerves can cause various problems leading to pain and dysfunction. So when a client comes to us with a complaint, we have to be able to mobilize nerves as effectively as we mobilize muscle.  

Neurodynamics is a term coined by physical therapists David Butler and Michael Shacklock to describe manual methods for mobilizing peripheral nerves.¹ Nerve mobilization includes nerve gliding and nerve tensioning. Nerve gliding, or flossing, is a manual technique where a therapist uses specific body positions and movements to pull a nerve back and forth along its path, similar to the action of dental floss. Nerve tensioning elongates a nerve by placing it under gentle, tensile force at both ends. When therapists use these techniques during a massage session, they passively move some areas of the client’s body while the client actively moves others to elicit the proper glide or tension on a nerve. In addition, many therapists teach clients to move their bodies in ways that mobilize the nerves as part of home-retraining exercises to maintain the positive results achieved during sessions.  

We can incorporate nerve mobilization methods with massage and other manual therapy techniques to help resolve common soft-tissue conditions like carpal tunnel, thoracic outlet syndrome, hip pain, piriformis syndrome, and more. Unfortunately, while physical therapists, occupational therapists, and athletic trainers use these procedures to increase the efficacy of treatment outcomes, many MTs have never learned these techniques.  

In this article, I’ll introduce neurodynamics and nerve mobilization methods. Then, we’ll look at an integrated routine to address cervical and brachial nerves using multiple manual methods, including nerve mobilization. The goal is to provide a routine you can immediately use to support clients exhibiting symptoms of neurogenic thoracic outlet, radial nerve entrapment, cubital tunnel, and carpal tunnel syndromes. If these techniques are a good fit for your bodywork career, I encourage you to seek training in nerve mobilization, which is advanced work requiring proficiency in anatomy, palpation, and client communication. 

A System Designed to Move  

We know the peripheral nervous system (PNS) relays information between the brain and body through 12 pairs of cranial nerves and 31 pairs of spinal nerves. The structure of a peripheral nerve consists of axons insulated with loose connective tissue, fibroblasts, a few mast cells, macrophages, and endoneurial fluid bundled together and protected by three connective tissue layers—the endoneurium, the perineurium, and the epineurium. Similar to the structure of muscle tissue, axons, Schwann cells, and endoneurial components are bundled by a covering of perineurium to form a nerve fascicle. Epineural tissue wraps several fascicles together to form a nerve. 

Scientists presenting a recent model of peripheral nerve structure point out that nerve fascicles are lubricated and designed for independent sliding within their connective tissue coverings. Furthermore, the layers of the endoneurium, perineurium, and epineurium join through viscoelastic connections allowing axons to glide and stretch throughout the length of the nerve. Peripheral nerves can elongate while maintaining the structural integrity of the delicate axons within.² 

Nerve Strain and Pressure   

We’ve learned that the design of peripheral nerves allows them to withstand significant amounts of nerve elongation, bend, and twist during movement. But imagine how nerve strain increases when a nerve must adapt to additional stress caused by faulty posture, altered joint position, and repetitive strain.  

With the initiation of limb movement, a nerve elongates first at the nerve segment adjacent to the moving joint. As limb movement continues, elongation occurs at nerve segments that are progressively more distant from the moving joint.³ Muscle, connective tissue, bone, blood in the nerve bed, scar tissue, or inflammation can tether a nerve segment at any point along the path of a nerve, placing it under greater tensile stress. Depending on the circumstances, the nerve might be damaged or irritated, leading to inflammation that creates an anatomical bottleneck or squeezes the nerve and surrounding blood vessels, impairing microcirculation.⁴  

Harvard University plastic surgeons Albert Upton and Alan McComas coined the term double crush syndrome. They state: “Neural function is impaired when compressed axons at one site cause the nerve to become especially susceptible to damage at another site.” Upton and McComas observed that a high percentage of patients with carpal, cubital, and radial tunnel syndromes also complained of unilateral shoulder, chest, and upper-back pain. While the mechanisms involved in double crush syndromes are not fully understood, clinicians believe that nerves become sensitized and the brain and spinal cord undergo changes in how they modulate pain.⁵  

While we could examine many peripheral nerve conditions, massage therapists often encounter thoracic outlet syndrome, radial nerve entrapment, cubital tunnel, and carpal tunnel syndromes.  

Neurogenic Thoracic Outlet Syndrome  

Most massage therapists know thoracic outlet syndrome is a group of disorders that occur when blood vessels and nerves are compressed as they travel through the space between the collarbone and first rib (thoracic outlet). Neurogenic thoracic outlet syndrome (NTOS) occurs when something compresses the branches of the brachial plexus, causing pain in the neck, shoulder, arm, or hand, a weakening grip, and numbness or tingling in the arm or fingers.  

Many things can cause NTOS, including the presence of an additional rib at C7, poor posture, trauma, joint fixations of the cervical spine, and systemic immune or metabolic disorders. Later in the article, we’ll focus on creating space for the brachial plexus as it travels through the interscalene triangle, under the subclavius and the pectoralis minor. Reducing hypertonicities in the scalene muscles, subclavius, and pec minor are essential before gliding and tensioning nerves. We’ll also want to watch for postural patterns that have weakened the trapezius and levator scapula, causing the shoulders to drop and fixating the clavicles on the first ribs.  

Radial Nerve Entrapment  

The radial nerve arises from the posterior cord of the brachial plexus. It descends obliquely down along the posterior surface of the humerus between the lateral and medial heads of the triceps. Anterior to the lateral epicondyle, the radial nerve splits into the superficial radial and posterior interosseous nerves. The posterior interosseous nerve runs along the radial neck before piercing the supinator muscle, a common site of entrapment. It then further divides into four terminal branches that various structures might also compress.  

While direct trauma and postsurgical complications can cause radial nerve issues, overuse actions that involve repetitive pronation and supination of the wrist and forearm are often the predominant factor in this condition. Therefore, before we glide and tension the radial nerve branches, we’ll focus on releasing hypertonic muscles, including the triceps, brachialis, brachioradialis, pronator, and supinator.  

Cubital Tunnel Syndrome  

The ulnar nerve travels with the median nerve along the medial side of the arm between the two heads of the biceps muscle. At the elbow, the ulnar nerve must travel through the cubital tunnel formed by the cubital tunnel retinaculum, which straddles a gap of about four millimeters between the medial epicondyle and the olecranon. The capsule and the posterior band of the medial collateral ligament of the elbow joint form the tunnel floor. While there are several locations where structures might compress the ulnar nerve, the cubital tunnel is the most common.  

Cubital tunnel syndrome is most common in people whose work involves prolonged periods of elbow flexion with the elbow pressed against a hard surface or sustained elbow flexion while sleeping. In our work, we’ll focus on reducing tension in the flexor carpi ulnaris before we glide and tension the ulnar nerve.  

Carpal Tunnel Syndrome  

Most massage therapists have worked with carpal tunnel syndrome, the most prevalent nerve compression condition in the US. This syndrome occurs when the median nerve is compressed in the carpal tunnel at the wrist, causing numbness, discomfort, and tingling in the lateral three-and-one-half digits. Compression of the median nerve occurs because the size of the tunnel decreases or the size of the contents passing through the tunnel increases.  

The tendons of the flexor digitorum superficialis, the flexor digitorum profundus, and the flexor pollicis longus travel with the median nerve through the tunnel. Massage therapists focus on reducing muscle hypertonicity in these muscles, reducing adhesions between structures, and reducing edema. We’ll also address the possibility that the proximal attachment of the pronator teres is compressing the median nerve above the cubital fossa.  

An Integrated Approach to Upper-Body Neurodynamics  

As with muscle and bone, nerves benefit from movement and suffer from sedentary lifestyles, fixed postures, and repetitive stress. Recent in-vitro studies showed that mechanical load applied to nerves initiates internal cell processes responsible for nerve myelination and homeostasis, including cell differentiation and neurite outgrowth.⁶ Myelin is an insulating layer that forms around nerves in the brain and spinal cord—the myelin sheath allows electrical impulses to transmit quickly along nerve cells. Neurite outgrowth refers to any projection from the cell body of a neuron—outgrowths can be either an axon or a dendrite. These processes are essential for general nerve health and repair following injury.⁷ 

It’s also interesting to note that the clinical outcomes are disappointing when nerve tensioning is the only intervention used to address compression-related conditions.⁸ Conversely, good results occur when both nerve gliding and tensioning are used along with other manual methods to ensure peripheral nerves glide smoothly through healthy surrounding tissue.⁹ 

The positive outcomes from integrated approaches to nerve issues include reduced nerve adherence, increased neural vascularity, reduced nerve stiffness, and reduced pain.¹⁰ In addition, as the pain subsides, the brain down-regulates sympathetic firing, and muscles stop splinting related joints, restoring pain-free, functional movement. 

I’ll now share an integrated approach to upper-body neurodynamics. While we might address upper-body nerve issues in multiple ways, this “routine” provides a general but effective starting point for therapists unfamiliar with these methods. We’ll use various manual methods that stretch muscles and move joints, beginning the process of mobilizing nerves. We’ll finish with nerve gliding and nerve tensioning. The goal of this routine is to produce excellent outcomes for clients focused on better functional movement or seeking intervention for mild symptoms of compression-related conditions. Remember, this work should not feel painful, and you should cease any movements that increase a client’s experience of pain or exacerbate other symptoms.    

To conclude, these techniques build your bodywork toolbox and give you a go-to routine for clients exhibiting symptoms of neurogenic thoracic outlet, radial nerve entrapment, cubital tunnel, and carpal tunnel syndromes. I also hope you feel excited about neurodynamics and its benefits for your bodywork career. Finally, I encourage you to seek out specific training in nerve mobilization because this is advanced work requiring proficiency in anatomy, palpation, and client communication. 

The Cervical Region  

This series of techniques for the cervical region reduces tension and imbalances in the neck muscles while mobilizing the cervical nerve roots to improve their health and function. Integrate these techniques with those you already use for your neck massage.

Crossed Arm Stretch 

Begin by sliding your right arm under the client’s neck and placing your right hand on the client’s left shoulder. Slide your left arm under your right arm so your left hand is on the client’s right shoulder. Slowly flex the client’s head to their first restrictive barrier. Hold this position for a breath and lower the head. Repeat this stretch 3–5 times as the neck muscles relax, and the client’s head moves further into flexion.  

Sidebending and Rotation Mobilization 

Remove your left hand from the client’s shoulder, allowing your right arm to form a fulcrum that comfortably supports the client’s head and neck. Grasp the client’s forehead with your left hand. Slowly begin to left sidebend and left rotate the client’s head to stretch the levator scapula and the splenius cervicis while mobilizing the cervical nerve roots. Working within the client’s comfort range, repeat this stretch 3–5 times to the left and then 3–5 times to the right.  

Scalene Nerve Stretch 

The brachial plexus passes through the anterior and medial scalene muscles. In contrast, the upper portion of the long thoracic nerve passes between the middle and posterior scalene. In this technique, we stretch the scalene muscles and mobilize these nerves. Your right hand slowly rotates, and the left sidebends the client’s neck to the first restrictive barrier using a counterforce between the left hand and the right forearm. Repeat this technique on the right side and then repeat the sequence 3–5 times, assessing the quality of the movement for improvement.  

Head Roll Mobilization

Use your left hand to initiate a counterclockwise, circular rolling motion using your right forearm as a fulcrum. Complete three large circles, then move your right hand from the client’s shoulder to use both hands to grasp and lower the client’s head to the therapy table.  

Decompress the Neck 

Grasp the client’s neck with both hands and lean your body weight back to gently decompress the client’s neck, upper traps, and sternocleidomastoid (SCM). Repeat the techniques shown in Images 4 and 5 up to five times.  

The Intertransversarii Stretch

The intertransversarii muscles extend between adjacent transverse processes beginning at C1 (although the muscle between C1 and C2 is often absent) and continuing to T1. Each ventral ramus of the cervical region leaves its spinal nerve of origin and exits the spine by passing posterior to the vertebral artery and then between the anterior and posterior intertransversarii muscles. This intertransversarii stretch relieves nerve root, trunk, and cord compression of the brachial plexus.  

Stand at the head of the table and grasp and slowly right rotate the client’s head to its restrictive barrier. Gently lift the client’s head and neck to its first flexion barrier. Ask the client to inhale to a count of five and gently extend the head back toward the table, against the therapist’s resistance. Slowly and gently lift the rotated head to the next flexion barrier as the client exhales. Repeat this stretch five times, and then left rotate the client’s head and repeat the procedure. Notice that minimal effort is needed to stretch these small muscles. Use caution during rotation and flexion efforts. Discontinue this stretch if the client reports discomfort.  

Chin-Jutting Mobilization

Place the flat palm of one hand under the back of your dominant hand and lift the client’s head and neck so that your wrists rest on the therapy table. Bring your thumbs ½-inch apart and place them into the lamina groove on either side of the spinous processes. Mobilize the client’s neck by pushing up with both thumbs into the groove. The rhythmic action juts the client’s chin as each vertebral segment (C2–3 to C7–T1) extends over the thumb fulcrum. Jut the client’s chin for two minutes.  

Sidebending Mobilization 

Your cupped palms support the client’s head as both of your thumbs pin the lateral body of the C5 spinous processes. Right sidebend the client’s neck with the right thumb pressing against the side of the spinous processes. Sidebend the client’s neck to the left with the left thumb pressing against the side of the spinous processes. Perform this technique bilaterally, working from C2 to T1 and back again.  

Translation and Undulation 

Your thumbs face inferiorly and brace each side of the client’s spinous processes. Step to your left foot and push your right thumb against the spinous processes. Step to your right foot and push your left thumb against the spinous processes. Use a rhythmic undulating motion as you rock back and forth, foot to foot, pushing on the bodies of the spinous processes from C2 to T1.  

Interscalene Triangle

The interscalene triangle is important because the roots of the brachial plexus and part of the subclavian artery pass through this area and impact the function of the upper extremity. The triangle’s borders are the anterior scalene, middle scalene, and the superior aspect of the first rib. This series of techniques creates space in the interscalene triangle to take pressure off the brachial plexus.  

Anterior Scalene Scrub 

With the client’s head left rotated, use your soft finger pads to glide along the client’s lateral neck and come under the clavicular border of the SCM. Next, your finger pads glide up onto the anterior scalene attachment on the client’s transverse processes (C2 to C6). Then, while the client performs slow, active chin tucks, you pin and scrub the scalene attachments up and down the client’s neck.  

Middle Scalene

To address tension in the middle scalene muscle, you’ll right rotate the client’s head to allow your thumb to gently contact the client’s middle scalene muscle. Your thumb (or soft finger pads) stretches the middle scalene attachment as the client slowly inhales and exhales. 

Subclavius and Pec Minor

Having “cleared” the cervical region, we’ll work to release the subclavius to create space for the branches of the brachial plexus in the costoclavicular canal and release the pec minor. Integrate these techniques with those you already use in your practice.  

Subclavius Scrub 

First, grasp the client’s right wrist with your left hand and walk to the opposite side of the table. Lift the client’s clavicle by pulling on their arm. Pronate your right wrist to allow your soft finger pads to glide gently under the client’s clavicle. Release the subclavius muscle by pulling the client’s wrist with your left hand while the finger pads of your right hand scrub the medial to lateral under the clavicle.  

First Rib Lever Technique 

This technique stretches the scalene muscles using the first rib as a lever to create space for the brachial plexus. Grasp your client’s right wrist with your left hand and abduct their arm so that you stand between the client’s arm and body. Get your body weight low and lift the client’s shoulder with your left hand while you snake your right hand under the client’s armpit to the left side of the client’s neck, with your soft finger pads reaching around the client’s trapezius to contact the first rib. Use your left hand to sidebend the client’s head to the left (to the side where you contact the first rib). In a rhythmic counterforce movement, rock the client’s head into left sidebending while you gently pull down on the first rib. Next, ask the client to inhale and push their head into right sidebending against your resistance (using your left hand to apply the resistance while your right hand continues to contact the first rib). Resist right sidebending to a count of five and instruct the client to exhale and relax while you apply the rhythmic counterforce movement to rock the client’s head into left sidebending. Apply this technique 3–5 times and then repeat it on the opposite side.  

Unilateral Elbow Pec Release

Having completed the bilateral elbow pec release, grasp the client’s left wrist with your left hand to internally and externally rotate the client’s arm while your forearm contacts the pec minor muscle at the coracoid process and resists external arm rotation. Apply this technique for approximately two minutes and then repeat this technique on the client’s right side.

Arm and Forearm Soft-Tissue Prep

Having cleared the subclavius and pec minor, we’ll move into this series of techniques for the arm and forearm to reduce muscle tension, roll fascial sacs across associated structures, and release adhered tissue. These techniques also introduce the brain to novel stimuli that capture the brain’s attention and help down-regulate sympathetic nervous system activity, releasing the region from protective muscle guarding. Integrate these techniques with methods you already use in your practice, such as applying friction strokes to the edges of the flexor and extensor muscles.  

Triceps Pull 

Prep the arm for nerve gliding and tensioning with a triceps pull. Begin with the client’s right arm horizontally abducted. Using your left hand, grasp the client’s wrist and slowly rotate the arm laterally as your right-hand reaches over the biceps to grasp the triceps and roll it anteriorly in a rhythmic pin-and-twist maneuver.  

Biceps Pull 

From the triceps pull, move into a biceps pull. The client’s arm is still horizontally abducted, but this time, your right hand grasps the client’s biceps and twists it superiorly while internally rotating the client’s arm.  

Biceps-Triceps Twist 

From the triceps twist, hold the client’s arm, extend their elbow, and tuck their forearm between your rib cage and arm. You are now facing the table. Next, move your body back to extend along the client’s elbow and grasp the triceps and biceps with both hands. Squeeze and compress these muscles as you twist your hands back and forth to roll the musculofascial bags over one another. As you work, begin to decompress the client’s shoulder by pulling and pushing it back and forth as you twist.  

Pronation Release 

Flex the client’s right elbow to 90 degrees and brace it against their side. Hold the client’s wrist in your right hand and use your left hand to pronate the client’s forearm to its first restrictive barrier. Ask the client to supinate their forearm against your resistance to a count of five and relax. Bring the client’s arm to the new pronation barrier and repeat the technique.  

Supination Release 

With the client’s arm in the same position as shown in Image 19, supinate the client’s forearm to its first restrictive barrier. Ask the client to pronate their forearm against your resistance to a count of five and relax. Next, bring the client’s arm to the new supination barrier and repeat the technique.   

Extension Release 

With your left hand, grasp the client’s right arm above the elbow to assess and treat extension restrictions. With your right hand, grasp the client’s hand and supinate the client’s arm. Next, extend the client’s arm to their first extension barrier. Ask the client to flex their biceps against your resistance to a count of five. Then, bring the client’s arm to the new extension barrier and repeat the technique.  

Nerve Gliding and Tensioning for the Radial, Ulnar, and Median Nerves

At the beginning of this article, I defined nerve gliding and tensioning. You’ll remember that nerve gliding, or flossing, is a manual technique where a therapist uses movement to pull a nerve back and forth along its path. Nerve tensioning elongates a nerve by placing it under gentle tensile force at both ends. When we apply these techniques during a massage session, a therapist passively moves some areas of the client’s body while the client actively moves others to elicit the proper glide or tension on a nerve. You can choose to use only the techniques that relate to the particular nerve you wish to mobilize, or you can use all of these techniques for a general, functional effect. At all times, this work should not increase pain or symptoms.  

Radial Nerve Gliding 

Move the client so their right shoulder is slightly off the edge of the therapy table. Use your left leg to depress and brace the client’s shoulder. If the client reports pain when you depress and brace their shoulder, they likely have an issue proximally. Address any proximal restrictions before you move forward with nerve mobilization.  

Ask the client to curl their fingers around their thumb while you snake your right hand under their extended elbow and grasp their wrist, gently pulling it into internal rotation. Your left hand grasps the client’s closed fingers to flex the wrist and ulnar deviate it. Continue to flex and ulnar deviate the client’s wrist. At the same time, you extend the client’s elbow, maintaining pain-free motion, and then release the tension allowing the client’s elbow and wrist to return to a more neutral position. Check in with the client to ensure this movement, which places the radial nerve under tension, doesn’t cause pain.  

Sidebending and Rotation 

Now, ask the client to left sidebend and left rotate their head and then bring it back to neutral, and continue to move into left sidebending and left rotation and back to neutral at a slow and rhythmic pace. As the client’s head comes into the neutral position, you flex and ulnarly deviate the wrist while bringing the elbow into extension. As the client’s head left sidebends and rotates, you bring the elbow, wrist, and hand into a neutral position. The client is pulling the nerve to the left, and you are pulling the nerve to the right. Continue at least five times to glide and floss the nerve.   

Radial Nerve Tensioning 

Next, as the client left sidebends and left rotates their head, you flex and ulnar deviate the wrist and bring the elbow into extension. Now the client is pulling the nerve left, and you are pulling the nerve right to tension the nerve. Remember, mobilization should not be painful. If it is painful, work slower and gentler.  

Ulnar Nerve Gliding 

Stand on the right side of your client and grasp their right hand. Horizontally abduct and externally rotate the client’s arm to 90 degrees. Snake your left hand under the client’s shoulder and grasp and depress the client’s shoulder to stabilize it. The client’s elbow is now braced against the therapist’s hip. With your right hand, radially deviate and extend the client’s wrist and fingers, paying particular attention to the fifth digit. Bring the deviated and extended wrist toward the client’s head. Continue to hold the client’s fingers and wrist in this position while directing them to right sidebend and right rotate their head, placing the nerve under increased tension. These movements should not cause an increase in pain.  

Sidebend and Rotate 

Bring the client’s wrist and fingers into a neutral position and begin gliding and flossing the nerve. Ask the client to right sidebend and right rotate their head and then come back to neutral, then continue to move into sidebending and right rotation and then back to neutral at a slow and rhythmic pace. As the client’s head comes into the neutral position, you radially deviate and extend the client’s wrist and fingers, bringing their hand closer to their head. You let off as the client sidebends and rotates. Continue in this way for at least five gliding maneuvers.  

Tensioning the Ulnar Nerve 

Next, as the client right sidebends and right rotates, you radially deviate and extend the client’s wrist and fingers, bringing their hand closer to their head to tension the nerve. Hold this position to a count of five, release, and repeat the tensioning maneuver three more times.  

Median Nerve Gliding

Using your left hand, grasp the client’s right arm above the elbow with the client’s arm abducted to 90 degrees. Rest your forearm on the table to brace the superior border of the client’s shoulder to stabilize it. With your right hand, grasp the client’s wrist and externally rotate the client’s arm. Your fingers contact and extend the client’s thumb, index, and middle fingers while supinating their wrist.  

Sidebending 

Ask the client to left sidebend their head and then return to neutral, and continue to move into sidebending and back to neutral at a slow and rhythmic pace. As the client comes into the neutral position, you extend the client’s wrist, fingers, and elbow. As the client sidebends, you release the pressure on the client’s wrist, fingers, and elbow. The client is pulling the nerve to the left, and you are pulling the nerve to the right to floss it. Continue these maneuvers for five cycles.  

Median Nerve Tensioning 

Now, as the client sidebends, you extend the client’s wrist, fingers, and elbow to tension the nerve. Hold to a count of five, release, and repeat this maneuver for five cycles.  

Notes

1. Michael Shacklock, Clinical Neurodynamics: A New System of Neuromusculoskeletal Treatment (Elsevier Health Sciences, 2005).  

2. Jaemyoung Sung et al., “Decoupled Epineurial and Axonal Deformation in Mouse Median and Ulnar Nerves,” Muscle & Nerve 59, no. 5 (May 2019): https://onlinelibrary.wiley.com/doi/10.1002/mus.26437.  

3. Kimberly Topp and Benjamin Boyd, “Structure and Biomechanics of Peripheral Nerves: Nerve Responses to Physical Stresses and Implications for Physical Therapist Practice,” Physical Therapy & Rehabilitation Journal 86, no. 1 (January 2006): 92–109, https://academic.oup.com/ptj/article/86/1/92/2805155.  

4. Stephen Carp, Peripheral Nerve Injury: An Anatomical and Physiological Approach for Physical Therapy Intervention (F. A. Davis, 2015).  

5. Rebecca Saunders et al., Hand and Upper Extremity Rehabilitation: A Practical Guide, 3rd ed. (Elsevier, 2006).  

6. Giacomo Carta et al., “The Neurodynamic Treatment Induces Biological Changes in Sensory and Motor Neurons In Vitro,” Scientific Reports 11, no. 1 (June 2021): 13277, www.nature.com/articles/s41598-021-92682-2.  

7. Suzanne Higgins et al., “Inducing Neurite Outgrowth by Mechanical Cell Stretch,” BioResearch Open Access 2, no. 3 (May 2013): 212–6, www.liebertpub.com/doi/10.1089/biores.2013.0008.

8. Ricardo Andrade et al., “Chronic Effects of Muscle and Nerve-directed Stretching on Tissue Mechanics,” Journal of Applied Physiology 129, no. 5 (November 2020): 1011–23, https://journals.physiology.org/doi/full/10.1152/japplphysiol.00239.2019.  

9. Robert Nee et al., “Neural Tissue Management Provides Immediate Clinically Relevant Benefits Without Harmful Effects for Patients with Nerve-related Neck and Arm Pain: A Randomized Trial,” Journal of Physiotherapy 58, no. 1 (March 2012): 23–31, www.sciencedirect.com/science/article/pii/S1836955312700693; Josué Fernández-Carnero et al., “Neural Tension Technique Improves Immediate Conditioned Pain Modulation in Patients with Chronic Neck Pain: A Randomized Clinical Trial,” Pain Medicine 20, no. 6 (June 2019), 1227–35, https://academic.oup.com/painmedicine/article/20/6/1227/5045167.

10. Richard Ellis et al., “Neurodynamics: Is Tension Contentious?” Journal of Manual & Manipulative Therapy 30, no. 1 (November 2021): 3–12, www.tandfonline.com/doi/full/10.1080/10669817.2021.2001736.